Provider Demographics
NPI:1720833015
Name:TAUFAHEMA, MATANGIAKE MEI MOANA (MS)
Entity Type:Individual
Prefix:
First Name:MATANGIAKE
Middle Name:MEI MOANA
Last Name:TAUFAHEMA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 HOOMALU ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2707
Mailing Address - Country:US
Mailing Address - Phone:808-295-8743
Mailing Address - Fax:
Practice Address - Street 1:203 KAPAA QUARRY PLACE #5002
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty